Provider Demographics
NPI:1629766621
Name:GREATHOUSE, WENDY ANN
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S RIDGECLIFF ST
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3903
Mailing Address - Country:US
Mailing Address - Phone:330-256-0996
Mailing Address - Fax:
Practice Address - Street 1:418 S RIDGECLIFF ST
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3903
Practice Address - Country:US
Practice Address - Phone:330-256-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide